Medicaid rolls surge, but not everywhere

Medicaid enrollment is surging, but states shunning Obamacare’s huge Medicaid expansion are getting left behind, according to data released Wednesday by HHS.

About 65 million people were enrolled in Medicaid and the closely related Children’s Health Insurance Program at the end of April, 6 million more than had been enrolled in the months leading up to Obamacare’s Oct. 1 launch. The numbers reflect a big spike in April, when 1.1 million additional people were enrolled in Medicaid compared to March.

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The 6 million total came overwhelmingly from 25 states that had expanded their Medicaid programs under the health care law by April. Those states saw a 15 percent surge in sign-ups — led by Oregon, West Virginia and Nevada, where Medicaid rolls climbed more than 40 percent.

States rejecting expansion saw a modest 3.3 percent increase, an average that includes substantial decreases in Wyoming, Missouri and Alabama.

“As we’ve seen for months, growth was more pronounced in states that adopted the Medicaid expansion,” wrote Cindy Mann, director of the federal Medicaid program, in a blog post announcing the new numbers.

HHS emphasized that actual Medicaid enrollment may be substantially higher because some people who signed up are still being processed for eligibility and a handful of states didn’t report complete numbers. In addition, New Hampshire recently embraced Medicaid expansion, but it won’t take effect broadly there until next year.

Medicaid enrollment has increasingly become a political weapon for Democrats, who argue that governors turning down the expansion are denying health care to as many as 6 million people. About a dozen Republican governors have embraced versions of Medicaid expansion, although some have been stymied by opposition from Republican legislatures.

Republicans say the Obama administration can’t be trusted to fulfill promises to generously fund Medicaid expansion over the long term. States pursuing expansion expect federal funds to cover the entire program for three years and at least 90 percent thereafter.

Hospitals, which had funds for covering the uninsured cut in the federal health law, have been clamoring for expansion because it’s expected to reduce pressure on their budgets and dramatically reduce the number of low-income patients who come through their doors without insurance.

Although the surge since fall correlates with the Obamacare enrollment period, the administration emphasized in its report Wednesday that “multiple factors” contributed to the changing numbers.

Medicaid enrollment related to the health care law has been difficult to pinpoint, in part because states report their enrollment numbers at different times and using different criteria. In addition, technical problems in federal and state enrollment systems have caused delays in determining who is eligible for Medicaid.